Right Ventricular Dysfunction and Dilatation, Similar to Left Ventricular Changes: RESULTS

11 Mar
2011

Ventricular Dysfunction

Catheter-Derived Hemodynamic Studies

Table 1 shows the hemodynamic changes from initial to final study in the 22 survivors and 17 nonsurvivors of septic shock.

Table 1—Initial to Final Hemodynamic Changes in Survivors and Nonsurvivors of Septic Shock

Survivors (n=22)
Nonsurvivors (n
= 17)


Parameters


Initial

Final

P*


Initial

Final

P

Heart
rate, beats/min

105

95

NSt

111

129

.006

Mean
arterial pressure, mm Hg

77

85

.017

74

74

NS


Pulmonary artery wedge pressure, mm Hg

13.7

9.6

.047

14

13.4

NS


Central venous pressure, mm Hg

9.5

4.4

.016

9.8

10.7

NS


Cardiac index, L/min/m2

4.1

4.1

NS

4.9

4.8

NS


Stroke volume index, ml/m2

39.9

42

NS

45.5

38.6

NS


Systemic vascular resistance index, dynes’s’cm^m2

1470

1691

NS

1262

1176

NS


Pulmonary artery mean pressure, mm Hg

22

17

.036

22

24

NS


Pulmonary vascular resistance index, dynes’s’cm^m2

204

150

NS

144

193

NS

Left
ventricular stroke work index, grn/m2

34

41

NS

37

34

NS

Right
ventricular stroke work index, g-m/m2

5.4

7.3

.03

7.2

6.3

NS

The changes from initial hemodynamic measurements to final studies in the survivors generally showed a return toward the normal range of the hemodynamic profile. The mean heart rate decreased from 105 to 95 beats/min, not a statistically significant difference. Mean arterial pressure increased significantly from 77 to 85 mm Hg (p = 0.017). Central venous pressure and pulmonary artery wedge pressure decreased significantly from 9.5 to 4.4 mm Hg (p = 0.016) and 13.7 to 9.6 mm Hg (p = 0.047), respec¬tively. There were no significant changes in cardiac index, stroke volume index, and systemic vascular resistance index. Pulmonary artery mean pressure fell from 22 to 17 mm Hg (p = 0.036), and right ventricular stroke work index increased from 5.4 to 7.3 g-m/m2 (p = 0.03). Pulmonary vascular resistance index and left ventricular stroke work index did not change significantly. cialis professional

Table 2—Initial to Final Ejection Fraction and End Diastolic Volume Index in Survivors and Nonsurvivors of Septic Shock

Nonsurvivors

Survivors (n:

= 22)

(n

= 17)

Parameters

Initial

Final

P*

Initial

Final

P

Left ventricular
ejection

fraction

.31

.47

.001

.40

.43

NSt

Left ventricular
end

diastolic volume
index,

ml/m2

145

106

.012

124

102

NS

Right ventricular
ejection

fraction

.35

.51

.001

.41

.39

NS

Right ventricular
end

diastolic volume
index,

ml/m2

124

88

.03

120

114

NS

♦Paired sample
t

test.

tNS indicates no
statistically significant.

In contrast, the nonsurvivors had no statistically significant change in any hemodynamic parameter from initial to final values except for an increase in heart rate from 111 to 129 beats/min (p = 0.006). Thus, the hemodynamic abnormalities in nonsurvivors of septic shock either worsened or were persistent throughout their courses.

Comparing the change from initial to final for the survivors with that of the nonsurvivors, the changes in heart rate, central venous pressure, pulmonary artery mean pressure, and pulmonary vascular resistance index were statistically significant. In each case the change in the survivors was toward normal, while in the nonsurvivors each parameter became more abnormal. canadian discount pharmacy


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